A Randomized, Controlled Trial to Test the Effectiveness of Patient Navigation in a Community versus Office-Based Setting to Improve Follow-up Appointment Adherence in Patients with Glaucoma

Abstract

Purpose : Patients with glaucoma who are non-adherent to follow-up appointment recommendations receive sub-optimal eye care and are at risk for developing more severe ocular disease. The primary goal of this study was to evaluate the use of a patient navigator to increase adherence to follow-up recommendations in community versus office-based settings.

Methods : Patients diagnosed with a glaucoma-related condition following a comprehensive eye exam at community sites in Philadelphia, were enrolled in this prospective, randomized, controlled trial. Patients were randomized into three groups for a 1- year period: Group 1 (G1) received follow-up eye care in a community setting with assistance from a patient navigator; Group 2 (G2) received follow-up eye care in an office-based setting with assistance from a patient navigator; Group 3 (G3) received follow-up eye care in an office-based setting without a patient navigator (usual care). Adherence rates were compared among these three groups using a chi-squared test at a significance level of 0.05.

Results : A total of 155 patients with glaucoma-related diagnoses were enrolled. The mean age (±SD) was 71.2 (±10.0) years. Patients were predominantly female (65.8%. n=102/155) and African-American (71.6%, n=111/155). The mean (±SD) number of follow-up visits during the 1-year study period was 1.3 (±1.3) for G1, 1.6 (±1.3) for G2, and 1.3 (±1.1) for G3 (P=0.48). Adherence rates, defined as attendance of at least 1 or more follow-up visit, were 69.8% (n=37/53) for G1, 82.5% (n=47/57) for G2, and 73.3% (n=32/45) for G3, (P=0.28). Sub-analysis of adherence rates for patients who attended ≥2 follow-up visits were 91.3% (n=21/23) for G1, 74.3% (n=26/35) for G2, and 66.7% (n=18/27) for G3, (P=0.11).

Conclusions : Adherence rates to follow-up recommendations were similar between community- and office- based settings. Considering that most patients diagnosed with glaucoma or glaucoma suspect were older African Americans, overall adherence rates were relatively high among this high-risk population.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.